title: Gender inequalities in the promptness of diagnosis of bladder and renal cancer after symptomatic presentation: evidence from secondary analysis of an English primary care audit survey.
abstract: OBJECTIVE
  To explore whether women experience greater delays in the diagnosis of bladder and renal cancer when first presenting to a general practitioner with symptoms caused by those cancers and potential reasons for such gender inequalities.
  
  
  METHODS
  Prospective national audit survey of cancer diagnosis.
  
  
  METHODS
  English primary care (2009-2010).
  
  
  METHODS
  920 patients with bladder and 398 patients with renal cancer (252 (27%) and 165 (42%), respectively, were women).
  
  
  METHODS
  Proportion of patients with three or more pre-referral consultations; number of days from first presentation to referral; proportion of patients who presented with haematuria and proportion of patients investigated in primary care.
  
  
  RESULTS
  Women required three or more prereferral consultations more often than men (27% (95% CI 21% to 33%) vs 11% (9% to 14%) for bladder (p<0.001); and 30% (22% to 39%) vs 18% (13% to 25%) for renal cancer (p=0.025)) and had a greater number of days from presentation to referral. In multivariable analysis (adjusting for age, haematuria status and use of primary care-led investigations), being a woman was independently associated with higher odds of three or more pre-referral consultations (OR=3.29 (2.06 to 5.25, p<0.001) for bladder cancer; and OR=1.90 (1.06 to 3.42, p=0.031) for renal cancer). Although presentation with haematuria was associated with more timely diagnosis of bladder cancer, gender inequalities did not vary by haematuria status for either cancer (p=0.18 for bladder and p=0.27 for renal). Each year in the UK, approximately 700 women with either bladder or renal cancer experience a delayed diagnosis because of their gender, of whom more than a quarter (197, or 28%) present with haematuria.
  
  
  CONCLUSIONS
  There are notable gender inequalities in the timeliness of diagnosis of urological cancers. There is a need to both reinforce existing guidelines on haematuria investigation and develop new diagnostic decision aids and tests for patients who present without haematuria.
authors.affiliation: Department of Public Health and Primary Care, Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK.
authors.forename: Georgios
authors.initials: G
authors.lastname: Lyratzopoulos
authors.forename: Gary A
authors.initials: GA
authors.lastname: Abel
authors.forename: Sean
authors.initials: S
authors.lastname: McPhail
authors.forename: Richard D
authors.initials: RD
authors.lastname: Neal
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Rubin
keywords: PRIMARY CARE; PUBLIC HEALTH